People as consumers are often assertive in ensuring they get what they want.

However people as patients are often reluctant to speak up.

They understate their concerns, or ask for what is less than desired to needed, or remain silent against their own better judgement. Often they will be confused about the choices available to them. Perhaps they don’t want to risk offending their treating clinicians, the experts.

There is a power imbalance in a clinician-patient relationship, which makes it very difficult to achieve true shared decision making.

In the article When Patients and Their Families Feel Like Hostages to Health Care, published in the September 2017 edition of the Mayo Clinic Proceedings, the authors (Leonard Berry, Tracey Danaher, Dan Beckham and Rana Awdish, and Kedar Mate) liken susceptible patients to “hostage bargaining syndrome” (HBS), whereby they behave as if negotiating for their health from a position of fear and confusion.

According to the authors, an awareness of ‘hostage bargaining syndrome’ is the first step in subverting it.

The clinicians must aim to be sensitive to the power imbalance inherent in the clinician-patient relationship. They should then actively and mindfully pursue shared decision making by helping patients trust that it is safe to communicate their concerns and priorities, ask questions about the available clinical options, and contribute knowledge of self to clinical decisions about their care. Hostage bargaining syndrome is an insidious psychosocial dynamic that can compromise quality of care, but clinicians often have the power to arrest it and reverse it by appreciating, paradoxically, how patients’ perceptions of their power as experts play a central role in the care they provide.